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Updated: Jun 24, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Systematic review and Bayesian network meta-analysis comparing multiple anastomotic techniques after total mesorectal
Daichi Kitaguchi1, Antonello Forgione2, Xavier Serra-Aracil3
1Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; Department of Gastrointestinal and Hepatobiliary and Pancreatic Surgery, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
Background:
Although several studies have performed pairwise comparisons of individual anastomotic techniques after total mesorectal excision (TME) for rectal cancer, there is a lack of comprehensive analyses, which simultaneously evaluate multiple techniques. This study aims to perform a systematic review and Bayesian network meta-analysis to compare the various anastomotic methods used after TME.
Methods:
This systematic review and Bayesian network meta-analysis included both randomized controlled trials (RCTs) and non-RCTs which evaluated outcomes of various anastomotic techniques in patients with rectal cancer undergoing TME. The techniques assessed included immediate handsewn anastomosis, delayed Turnbull-Cutait anastomosis (TCA), double-stapling technique (DST), and transanal transection and single-stapled (TTSS) anastomosis. The primary outcome was the proportion of anastomotic leakage (AL). Secondary outcomes included overall postoperative morbidity and postoperative anorectal function.
Results:
A total of 13 studies were included, comprising two RCTs and 11 non-RCTs, with a combined total of 2710 patients. TTSS was associated with a lower proportion of AL as compared to both the DST group (RR: 0.43, 95% CrI: 0.21-0.87) and the immediate handsewn group (RR: 0.35, 95% CrI: 0.13-0.74). TCA was also associated with a significantly lower proportion of AL as compared to the immediate handsewn group (RR: 0.42, 95% CrI: 0.21-0.80). No statistically significant differences were observed between groups regarding overall postoperative morbidity or anorectal function.
Conclusions:
The findings of this study suggest that TTSS may be associated with a lower risk of postoperative AL after TME for rectal cancer; however, the certainty of evidence was low, and the findings should be interpreted with caution.
